Radiology: MRI not helpful in whiplash diagnosis

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MR images of patients with whiplash injuries, while able to provide some rare evidence of cervical spine changes, may have limited clinical relevance due to low sensitivity, disagreement between readers and difficulties distinguishing whiplash-associated injury from age-related changes, according to a study published online on Dec. 20 in Radiology.

When the study was being designed, the authors, including Suzanne E. Anderson, MD, of the University of Bern, in Switzerland, and colleagues expected whiplash-related MR imaging findings to be minor, but they were surprised by the lack of agreement among readers in distinguishing post-traumatic spinal changes from age-related degeneration. The four experienced readers used in the study even participated in relevant teaching sessions and defined a list of potential findings prior to the study.

“Despite this specific education and training process for already experienced readers, MR imaging seemed less than helpful in the diagnosis of acute whiplash injury in this study,” wrote the authors.

The findings were based on a prospective, multicenter controlled study of 100 consecutive patients who underwent 1.5T MR imaging exams within 48 hours of a motor vehicle accident from 2005 to 2008. These images were blindly compared with 100 age- and sex-matched healthy control subjects.

Results showed a low sensitivity of 0.328 for MR imaging, and a moderate specificity of 0.728. Inter-reader reliability was reported as poor, as well.

The researchers were able to demonstrate some findings associated with acute whiplash injury on MR images, including bone contusions and muscle strains, but these findings were rare and also found in the healthy control subjects.

“They indicate that in rare cases, traumatic cervical spine lesions do occur, but such lesions currently do not necessarily provide the cause of any symptoms or indicate specifically ‘more relevant’ or ‘more severe’ injury,” wrote the authors. “Whether they have any clinical relevance remains to be evaluated.”

Muscle tears were the only finding present in the patient group and not the control group and there were no serious occult injuries requiring immediate therapy.

Due to the overlap of whiplash-related findings and age-related changes, the researchers suggested that future investigations should focus on distinguishing between post-traumatic and degenerative findings.

Whiplash-associated injuries come at a steep price, with trauma payments costing $7 billion in the U.S., according to the study’s background information.